GPs Need Better Education on All Symptoms of PCOS, Say Patients

Pam Harrison

March 19, 2020

Women who have polycystic ovary syndrome (PCOS) often feel their general practitioners (GPs) trivialize the condition as only a fertility problem and do not discuss any of the other long-term health consequences, new results from a UK survey reveal.

"Women with PCOS may seek advice or treatment in primary care for various conditions that are associated with the syndrome, including infertility, miscarriage, obesity, type 2 diabetes, sleep apnea, hirsutism, and acne," say the survey authors, led by Sarah C. Hillman, PhD, of the Warwick Medical School, UK.

PCOS can also adversely affect mental health and carries an increased risk of endometrial hyperplasia and nonalcoholic fatty liver disease (NAFLD), they add.

GPs therefore need much more education to improve their awareness about the condition, they conclude.

"We found that women weren't being told about the long-term increased risk [associated with PCOS] or were only told about some of them," said Hillman in a statement. "We should be viewing it as a condition that affects women in a number of ways throughout their life course. It is not just about ovaries," she added.

"Future work should focus on improving awareness of GPs and the public about the effects of PCOS on immediate and longer-term conditions associated with PCOS, and on interventions to reduce the risks of type 2 diabetes and endometrial hyperplasia," Hillman and colleagues conclude.

The study was published online in the British Journal of General Practice.

Over 80% of Women Feel They Could Have Had Better Care

The survey consisted of 36 items and was accessible online between January and November 2018 for women with PCOS. A total of 323 women completed the survey, and larger, structured interviews were done with 11 of them.

The average age of respondents was 35.4 years.

The median time from presentation with symptoms to a diagnosis of PCOS was between 6 and 12 months.

Upon diagnosis, "survey responses showed that 69.6%...of women said they had discussed their fertility with a GP and 71%...reported having problems with their fertility," Hillman and colleagues note.

White British women were more likely to discuss their fertility with their GPs, with 75.8% of these patients doing so, compared with other women who identified as British Asian (60.7%) or another ethnic group, at 55% (P = .038), the investigators add.

On the other hand, only about one third of women with a body mass index (BMI) in the overweight category and about half of those with a BMI that classified them as obese recalled discussing weight loss with their GP, even though over 80% of survey respondents reported having a BMI that placed them in the overweight or obese category.

"Women were [also] asked if their GP discussed health conditions that may be associated with PCOS," the authors observe.

Only 19% of respondents could recall having had any such discussion on complications such as diabetes, and this was the most frequently discussed complication, with sleep apnea, NAFLD, and endometrial hyperplasia getting even less attention.

And almost three quarters of respondents reported that PCOS had adversely affected their mental health yet only about one third recalled having ever discussed mental health issues with their GP.

Again, white women were much more likely to discuss the state of their mental health with their GP than women from other ethnic groups.

And when women were asked about medications they had been prescribed to help alleviate their symptoms, they felt that antidepressants were overprescribed.

More than 80% of respondents said they felt their GP could have done more to help them better manage their symptoms.

Some women did describe their interactions with medical professionals as positive. This was most likely to occur when they felt that their GP had taken the diagnosis seriously and they had been listened to.

On the other hand, "from the participants' perspectives, potentially serious associated comorbidities had been inconsistently considered, screened, and followed up in general practice," the researchers note.

"[And] women were dissatisfied with the amount of information provided regarding the condition and how it can be managed," they add.

They suggest that healthcare professionals become better acquainted with interventions that might reduce the risk of developing these longer-term complications.

"The word 'ovary' in the name suggests to people that this is a problem just around ovaries, but it is just one piece of the jigsaw puzzle of the health of these women," noted Hillman.

"Getting the right information to women in a timely fashion makes that information empowering," she pointed out. "For instance, if you know you're at higher risk of diabetes, you may focus more on weight control."

The study was funded by a scientific foundation board practitioner allowance grant from the Royal College of General Practitioners. The authors have no competing interests to declare.

Br J Gen Pract. Published online March 9, 2020. Full text

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